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Process evaluation of schistosomiasis control in Uganda, 2003 to 2006: perceptions, attitudes and constraints of a national programme

  • F. M. FLEMING (a1), A. FENWICK (a1), E. M. TUKAHEBWA (a2), R. G. N. LUBANGA (a3), H. NAMWANGYE (a2), S. ZARAMBA (a4) and N. B. KABATEREINE (a2)...

Schistosomiasis is widespread in Uganda along large lakes and rivers with approximately 4 million people infected. Hookworm infections also prevalent throughout the country, while infections with Ascaris lumbricoides and Trichuris trichiura are mainly found in south-western Uganda. A national programme aimed at controlling morbidity due to these infections was launched in 2003. This article describes the perceptions, attitudes, constraints and experiences of those implementing the programme and those receiving the treatment. The study used qualitative data collected largely in two districts but also from 18 other districts implementing the programme. Results showed that mass treatment was perceived to be beneficial because the drugs make people feel better. However, side-effects of praziquantel (PZQ), the smell and size of the tablets and the use of height, not weight, to determine dose were raised as major factors discouraging people from taking the drug. Generally, most of the end-users were appreciative of the programme and were beginning to demand regular treatment. Nevertheless, intensive and sustained health education is still vital for improvement of treatment coverage, especially among the non-compliers. It was repeatedly highlighted that there is a need to stock PZQ in all health facilities in endemic areas. Provision of incentives to drug distributors and to involve as many stakeholders as possible in the planning phase were also raised by respondents. Lessons learned for the development and success of a helminth control programme at a national scale are discussed.

Corresponding author
*Corresponding author: Schistosomiasis Control Initiative, Department of Infectious Disease Epidemiology, Imperial College London, St. Mary's Campus, Norfolk Place, London, W2 1PG, UK. Tel: +44 (0)20 7594 3626; Fax: +44 (0)20 7262 8140. E-mail:
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Ali M. I., Byskov J., Mokgweetsinyana S. S., Sibiya J. and Mott K. E. (1989). Integration of control of schistosomiasis due to S. mansoni within primary health care in Ngamiland, Botswana. Tropical Medicine and Parasitology 4, 195200.
Anguzu J., Oryema-Lalobo M., Oundo G. B. and Nuwaha F. (2007). Community perception of intestinal schistosomiasis in Busia district in Uganda. East African Medical Journal 84, 5666.
Asaolu S. O. and Ofoezie I. E. (2003). The role of health educations and sanitation in the control of helminth infections. Acta Tropica 86, 283294.
Brooker S., Kabatereine N. B., Fleming F. and Devlin N. (2008). Cost and cost-effectiveness of nationwide school-based helminth control in Uganda: intra-country variation and effects of scaling-up. Health Policy and Planning 23, 2435.
Brooker S., Marriot H., Hall A., Adjei S., Allan E., Maier C., Bundy D. A. P., Drake L. J., Coombes M. D., Azene G., Lansdown R. G., Wen S. T., Dzodemenyo M., Cobbinah J., Obro N., Kihamia C. M., Issae W., Mwanri L., Mweta M. R., Mwaikemwa A., Salimu M., Ntimbwa P., Kiwelu V. M., Turuka A., Nkungu D. R. and Magingo J. (2001). Community perception of school-based delivery of anthelmintics in Ghana and Tanzania. Tropical Medicine and International Health 6, 10751083.
Cioli D. and Pica-Mattoccia L. (2003) Praziquantel. Parasitology Research 90, S3S9.
Danso-Appiah A., de Vlas S. J., Bosompem K. M. and Habbema J. D. F. (2004). Determinants of health-seeking behaviour for schistosomiasis-related symptoms in the context of integrating schistosomiasis control within the regular health services in Ghana. Tropical Medicine and International Health 9, 784794.
Ekeh H. E. and Adeniyi J. D. (1988). Health education strategies for tropical disease control in schoolchildren. Journal of Tropical Medicine and Hygiene 91, 5559.
Gryseels B., Polman K., Clerinx J. and Kestens L. (2006). Human schistosomiasis. Lancet 368, 11061118.
Jarallah J. S., Al Shammari S. A., Khoja T. A. and Al Sheikh M. (1993). Role of primary health care in the control of schistosomiasis: the experience in Riyadh, Saudi Arabia. Tropical and Geographical Medicine 45, 297300.
Kabatereine N. B., Brooker S., Koukounari A., Kazibwe F., Tukahebwa E. M., Fleming F. M., Zhang Y., Webster J. P., Stothard J. R. and Fenwick A. (2007). Impact of a national helminth control programme on infection and morbidity in Ugandan schoolchildren. Bulletin of the World Health Organization 85, 9199.
Kabatereine N. B., Brooker S., Tukahebwa E. M., Kazibwe F. and Onapa A. W. (2004). Epidemiology and geography of Schistosoma mansoni in Uganda: implications for planning control. Tropical Medicine and International Health 9, 372380.
Kabatereine N. K., Fleming F. M., Nyandindi U., Mwanza J. C. L. and Blair L. (2006 b). The control of schistosomiasis and soil-transmitted helminths in East Africa. Trends in Parasitology 22, 332339.
Kabatereine N. B., Kemijumba J., Ouma J. H., Sturrock R. F., Butterworth A. E., Madsen H., Ørnbjerg N., Dunne D. W. and Vennervald B. J. (2003). Efficacy and side-effects of praziquantel treatment in a highly endemic Schistosoma mansoni focus at Lake Albert, Uganda. Transactions of the Royal Society of Tropical Medicine and Hygiene 97, 599603.
Kabatereine N. B., Tukahebwa E., Kazibwe F., Namwangye H., Zaramba S., Brooker S., Stothard J. R., Kamenka C., Whawell S., Webster J. P. and Fenwick A. (2006 a). Progress towards countrywide control of schistosomiasis and soil-transmitted helminthiasis in Uganda. Transactions of the Royal Society of Tropical Medicine and Hygiene 100, 208215.
Kabatereine N. B., Tukahebwa E. M., Kazibwe F., Twa-Twa J. M., Barenzi J. F., Zaramba S., Stothard J. R., Fenwick A. and Brooker S. (2005). Soil-transmitted helminthiasis in Uganda: epidemiology and cost of control. Tropical Medicine and International Health 10, 11871189.
Katabarwa M. N, Mutabazi D. and Richards F. O. Jr. (1999). The community-directed, ivermectin-treatment programme for onchocerciasis control in Uganda–an evaluative study (1993–1997). Annals of Tropical Medicine and Parasitology 93, 727735.
Katabarwa M. N., Mutabazi D. and Richards F. O. Jr. (2000). Controlling onchocerciasis by community-directed, ivermectin-treatment programmes in Uganda: why do some communities succeed and others fail? Annals of Tropical Medicine and Parasitology 94, 343352.
Landouré A., van der Werf M. J., Traoré M. and de Vlas S. J. (2003). Evaluation of case management in the integrated schistosomiasis-control programme in Mali. Annals of Tropical Medicine and Parasitology 97, 723736.
Lansdown R., Ledward A., Hall A., Issae W., Yona E., Matulu J., Mweta M., Kihamia C., Nyandindi U. and Bundy D. (2002). Schistosomiasis, helminth infection and health education in Tanzania: achieving behaviour change in primary schools. Health Education Research 17, 425433.
Lwambo N. J., Siza J. E. and Mwenda G. C. (2005). Community's willingness to pay for a school-based chemotherapy programme to control morbidity due to schistosomiasis and soil-transmitted helminthiasis in children in rural Tanzania. Tanzania Health Research Bulletin 7, 149153.
Massa K., Magnussen P., Sheshe A., Ntakamulenga R., Ndawi B. and Olsen A. (2009). Community perceptions on the community-directed treatment and school-based approaches for the control of schistosomiasis and soil-transmitted helminthiasis among school-age children in Lushoto, Tanzania. Journal of Biosocial Science 41, 89105.
Montresor A., Engels D., Chitsulo L., Bundy D. A. P., Brooker S. and Savioli L. (2001). Development and validation of a ‘tablet pole’ for the administration of praziquantel in sub-Saharan Africa. Transactions of the Royal Society of Tropical Medicine and Hygiene 95, 542544.
Mwanga J. R., Magnussen P., Mugashe C. L., Gabone R. M. and Aagaard-Hansen J. (2004). Schistosomiasis-related perceptions, attitudes and treatment-seeking practices in Magu district, Tanzania: public health implications. Journal of Biosocial Science 36, 6381.
Nuwaha F., Okware J. and Ndyomugyenyi R. (2005). Predictors of compliance with community-directed ivermectin treatment in Uganda: quantitative results. Tropical Medicine and International Health 10, 659667.
Nwaorgu O. C., Okeibunor J., Madu E., Amazigo U., Onyegegbu N. and Evans D. (1998). A school-based schistosomiasis and intestinal helminthiasis control programme in Nigeria: acceptability to community members. Tropical Medicine and International Health 3, 842849.
Parker M., Allen T. and Hastings J. (2008). Resisting control of neglected tropical diseases: dilemmas in the mass treatment of schistosomiasis and soil-transmitted helminths in north-west Uganda. Journal of Biosocial Science 40, 161181.
Poggensee G., Krantz I., Nordin P., Mtweve S., Ahlberg B., Mosha G. and Freudenthal S. (2005). A six-year follow-up of schoolchildren for urinary and intestinal schistosomiasis and soil-transmitted helminthiasis in Northern Tanzania. Acta Tropica 93, 131140.
Raso G., N'Goran E. K., Toty A., Luginbühl A., Adjoua C. A., Tian-Bi N. T., Bogoch I. I., Vounatsou P., Tanner M. and Utzinger J. (2004). Efficacy and side-effects of praziquantel against Schistosoma mansoni in a community of western Côte d'Ivoire. Transactions of the Royal Society of Tropical Medicine and Hygiene 98, 1824.
Utzinger J., Bergquist R., Xiao S. H., Singer B. H. and Tanner M. (2003). Schistosomiasis control – the way forward. Lancet 362, 19321934.
van der Werf M. J., de Vlas S. J., Landouré A., Bosompem K. M. and Habbema J. D. F. (2004). Measuring schistosomiasis case management of the health services in Ghana and Mali. Tropical Medicine and International Health 9, 149157.
Wang L., Utzinger J. and Zhou X. N. (2008). Schistosomiasis control – experience and lessons from China. Lancet 372, 17931795.
Webster J., Worrall E., Hill J., Hanson K. and Lines J. (2004). Strengthening the potential of health systems in rural Africa. British Medical Journal 328,
Zhou X. N., Wang L. Y., Chen M. G., Wu X. H., Jiang Q. W., Chen X. Y., Zheng J. and Utzinger J. (2005). The public health significance and control of schistosomiasis in China–then and now. Acta Tropica 96, 97105.
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